Endocrine Abstracts

Background: Surgery is indicated for patients with prolactinomas if intolerant of or resistant to medical therapy with dopamine agonists. The transphenoidal route offers fast relief from symptoms in the hands of an experienced surgeon, with remission achieved in up to 87% of microprolactinomas and 56% in macroprolactinomas.¹

Aim: To evaluate the outcome of transsphenoidal adenectomy for non-responsive prolactinomas in a single centre in the UK.

Methods: The case notes of 12 patients (10 females, mean age at operation 33.8 years ±9.3) who underwent transphenoidal adenectomy since July 2004 as treatment for prolactinomas either due to resistance to or intolerance of medical therapy or due to deteriorating visual fields, were reviewed. Pituitary function tests pre-operatively, in the immediate post-operative period and at six weeks after surgery were scrutinised.

Results: Of the 12 patients; three had macroprolactinomas and the rest microprolactinomas. Prior to surgery the mean serum prolactin level was 2443 mIU/l (921–7821). All patients except one developed a fall in prolactin level (pre-op mean 2407±1923 to post-op 498±525). Six weeks after surgery seven patients (58%) had achieved normalisation of the prolactin levels. Five patients (42%) continued to have elevated prolactin levels post-operatively (one macro, four micro); mean 987 mIU/l (567–1603). In this small series no differences in outcome was noted in the two groups (cure rate: macro 66%, micro 56%).

Complications included a CSF leak (1), panhypopitutarism (1), adrenal insufficiency (2), persistent diabetes insipidus (2) and growth hormone deficiency (2).

Conclusions: The transphenoidal approach remains a useful technique to manage patients with prolactinomas refractory to medical therapy. Normo/hypoprolactenaemia was achieved in seven out of 12 patients (58%) using this technique. Hypopituitarism remains a significant complication.

References: 1. Jane JA & Laws ER. The surgical management of pituitary adenomas in a series of 3093 patients. J Am Coll Surg 2001 193 651–659.